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NPI Code Detail

MEDICARE: ROSEWOOD CARE CENTER, INC OF EAST PEORIA

MEDICARE: ROSEWOOD CARE CENTER, INC OF EAST PEORIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)1303690001IL
2314000000XSkilled Nursing Facility0035204IL

General Provider Information

NPI Number : 1528063443
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSEWOOD CARE CENTER, INC OF EAST PEORIA
Provider Business Mailing Address
First Line : 11701 BORMAN DR
Second Line : STE 315
City : SAINT LOUIS
State : MO
Zip : 63146-4194
Country : US
Telephone Number : 314-994-9070
Fax Number :
Provider Business Practice Location Address
First Line : 900 CENTENNIAL DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-4928
Country : US
Telephone Number : 309-699-5400
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LARRY VANDER MATEN
Credential :
Telephone Number : 314-994-9070
Provider Enumeration Date : 06/16/2005
Last Update Date : 04/20/2008

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Directions to “ROSEWOOD CARE CENTER, INC OF EAST PEORIA ” Practice Location

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